Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors

Abstract Purpose The aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications. Methods All patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications. Results Data from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01–1.04], surgery duration (OR, 1.02; 95% CI 1.02–1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01–1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21–1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications. Conclusion In this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.

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Independent Risk Factors for Impaired Early Outcome after Isolated Ankle Fracture – A Multivariate Analysis and Prognostic Models

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1200-2504 ◽

2020 ◽

Author(s):

Alexander Kaltenborn ◽

Michael Bullok ◽

Christoph Schulze ◽

Sebastian Hoffmann ◽

Peter Springer ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Operative Therapy ◽

Current Data ◽

Ankle Fractures ◽

Prognostic Models ◽

Binary Logistic Regression Analysis ◽

Roc Curve Analysis ◽

Prolonged Length ◽

Independent Risk Factors

Abstract Background Ankle fractures are common operative indications in orthopedic surgery. Their incidence is increasing. Objectives To identify independent risk factors and to develop prognostic models for the prediction of prolonged length of hospital stay (LOS) and the onset of postoperative complications. Materials and Methods This is a single-center, retrospective, observational study analyzing data of 154 consecutive, isolated, surgically treated ankle fractures. Multivariate binary logistic regression analysis was applied to identify significant independent risk factors. The validity and clinical applicability of the developed prognostic models was assessed with ROC-curve analysis (ROC: Receiver Operating Characteristic). Internal validation of prognostic models was performed with randomized backwards bootstrapping. Results The median LOS was 7 days. 50 patients (33%) had a longer LOS. 13% of operated patients had a postoperative complication (n = 20). Independent preoperative risk factors for prolonged length of stay were leukocytosis (p = 0.020; OR: 1.211), an increased CRP-level (p = 0.005; OR: 1.901), as well as a bi- (p = 0.002; OR: 15.197) or trimalleolar (p = 0.001; OR: 10.678) fracture type. Immediate operative therapy was an independent beneficial factor (p < 0.001; OR: 0.070). The onset of complications was associated significantly with diabetes mellitus (p = 0.004; OR: 9.903) and an elevated ASA score (p = 0,004; OR: 3.574). The developed prognostic models for the prediction of prolonged LOS (AUROC: 0.736) and postoperative complications (AUROC: 0.724) had a good clinical validity and were internally validated. Conclusion The current data pronounce the importance of preoperative laboratory works. Furthermore, co-morbidities play a major role in the prognosis of outcome. The developed prognostic models are able to reliably predict the outcome and enable the preoperative identification of high-risk patients.

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A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

World Journal of Surgery ◽

10.1007/s00268-021-05985-w ◽

2021 ◽

Author(s):

Koichi Tomita ◽

Itsuki Koganezawa ◽

Masashi Nakagawa ◽

Shigeto Ochiai ◽

Takahiro Gunji ◽

...

Keyword(s):

Risk Factors ◽

Skeletal Muscle ◽

Postoperative Complications ◽

Elderly Patients ◽

Risk Score ◽

Surgical Procedure ◽

Evaluation Method ◽

Preoperative Risk ◽

Preoperative Serum ◽

Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

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Patient determinants as independent risk factors for postoperative complications of breast reconstruction

Gland Surgery ◽

10.21037/gs.2017.04.04 ◽

2017 ◽

Vol 6 (4) ◽

pp. 355-367 ◽

Cited By ~ 11

Author(s):

Andri Thorarinsson ◽

Victoria Fröjd ◽

Lars Kölby ◽

Mattias Lidén ◽

Anna Elander ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Breast Reconstruction ◽

Independent Risk Factors

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Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

10.21203/rs.3.rs-161144/v1 ◽

2021 ◽

Author(s):

Miao He ◽

Qinghong Fan ◽

Yuhang Zhu ◽

Dexing Liu ◽

Xingxing Liu ◽

...

Keyword(s):

Risk Factors ◽

Nutritional Assessment ◽

Femoral Fractures ◽

Prognostic Nutritional Index ◽

Adverse Outcomes ◽

Major Influence ◽

Binary Logistic Regression Analysis ◽

Complication Rates ◽

Nutritional Index ◽

Independent Risk Factors

Abstract Background: Surgery is usually the best treatment for patients with femoral fractures. However, the incidence of perioperative adverse outcomes in such cases is quite high. Nutrition has a major influence on fracture healing, and malnutrition is associated with higher complication rates, higher mortality rates, and longer hospitalisation periods. In this study, we aimed to identify independent risk factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods: This retrospective observational study included 343 patients who underwent surgery for a single femur fracture at the Affiliated Hospital of Zunyi Medical University in 2018. Binary logistic regression analysis was applied to identify significant independent risk factors. The discriminatory ability of independent predictors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results: In total, 159 patients (46.4%) had perioperative adverse outcomes. PNI (OR: 0.819, 95% CI: 0.754–0.889, P < 0.001), age (OR: 1.042, 95% CI: 1.020–1.066, P < 0.001), time to admission (OR: 1.404, 95% CI: 1.117–1.765, P = 0.004), hypertension (OR: 1.912, 95% CI: 1.049–3.488, P = 0.034), combined injures (OR: 2.739, 95% CI: 1.338–5.607, P = 0.006), and operation types (OR: 3.696, 95% CI: 1.913–7.138, P < 0.001) were independent factors for perioperative adverse outcomes. Based on the AUC (PNI: 0.772, 95% CI: 0.723–0.821, P < 0.001; age: 0.678, 95% CI: 0.622–0.734, P < 0.001; time to admission: 0.585, 95% CI: 0.525–0.646, P = 0.006), the PNI had the optimal discrimination ability, indicating its superiority over other independent predictors (age vs. PNI, P = 0.002; time to admission vs. PNI, P < 0.001). Conclusions: This study showed that the PNI was a better and effective independent predictor of perioperative adverse outcomes in patients with femoral fractures. Our findings suggest that nutritional assessment at admission and appropriate intervention strategies are necessary for patients with femoral fractures.

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Risk Factors and Neurologic Outcomes in Patients With Traumatic Brain Injury and Coagulopathy Within 72 Hours Post-operatively

10.21203/rs.3.rs-145018/v1 ◽

2021 ◽

Author(s):

Tao Chang ◽

Xigang Yan ◽

Chao Zhao ◽

Yufu Zhang ◽

Bao Wang ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Logistic Regression ◽

Brain Injury ◽

Multivariate Logistic Regression ◽

Neurologic Outcomes ◽

Post Operative Period ◽

Duration Of Surgery ◽

Independent Risk Factors ◽

Time Of Admission

Abstract Background There are few studies on the development and effect of coagulopathy in patients with a traumatic brain injury (TBI) during the early post-operative period. We determined the risk factors and neurologic outcomes of in patients with a TBI and coagulopathy diagnosed by routine laboratory tests within 72 hours post-operatively. Methods The baseline characteristics, intra-operative management, and follow-up results of 462 patients with TBIs were obtained and retrospectively analyzed by multivariate logistic regression from January 2015 to June 2019. Coagulopathy was defined as an activated partial thromboplastin time > 40 seconds, international normalized ratio >1.4, or a platelet count < 100×109 /L.Results Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) at the time of admission, Injury Severity Score (ISS) at the time of admission, pupil mydriasis, duration of surgery, intra-operative blood loss, and intra-operative crystalloid resuscitation were independent risk factors for patients who developed a coagulopathy post-operatively. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed a trend for higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Furthermore, coagulopathy and contusion expansion in the early post-operative period were independent risk factors for TBI mortality after surgery. Intra-operative crystalloid resuscitation had a substantial diagnostic accuracy in predicting coagulopathy within 72 h post-operatively (area under the curve [AUC] = 0.972).Conclusion Coagulopathy within 72 h post-operatively in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes. Hence, we should take practical and reasonable measures to manage these risk factors, which may protect patients with a TBI from post-operative coagulopathy.

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Surveillance of healthcare-associated infections in a Tunisian university hospital

European Journal of Public Health ◽

10.1093/eurpub/ckz186.513 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Hannachi ◽

A Ben Cheikh ◽

S Bhiri ◽

H Ghali ◽

S Khefacha ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

University Hospital ◽

Healthcare Associated Infections ◽

Drug Resistant ◽

Healthcare Associated Infection ◽

Carbapenem Resistant ◽

Independent Risk Factors ◽

Healthcare Associated

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

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Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-01962-4 ◽

2020 ◽

Vol 405 (7) ◽

pp. 977-988

Author(s):

Oliver Beetz ◽

Clara A. Weigle ◽

Sebastian Cammann ◽

Florian W. R. Vondran ◽

Kai Timrott ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Postoperative Complications ◽

Intrahepatic Cholangiocarcinoma ◽

Postoperative Morbidity ◽

Severity Index ◽

The Body ◽

Morbidity And Mortality ◽

Independent Risk Factors ◽

Risk Factors For Survival

Abstract Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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Impact of postoperative complications on pancreatic cancer survival and recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.446 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 446-446

Author(s):

Masahiro Asari ◽

Toru Aoyama ◽

Yusuke Katayama ◽

Masaaki Murakawa ◽

Koichiro Yamaoku ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Cancer ◽

Overall Survival ◽

Postoperative Complications ◽

Cancer Survival ◽

Disease Recurrence ◽

Lymphatic Invasion ◽

Curative Surgery ◽

Independent Risk Factors ◽

The Impact

446 Background: We investigated the impact of postoperative complications on pancreatic cancer survival and recurrence after curative surgery. Methods: This study included 164 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. The patients were classified into those with postoperative complications (C group) and those without postoperative complications (NC group). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. Results: Postoperative complications were found in 61 of the 164 patients (37.2%). The RFS rate at five years after surgery was 10.6% in the C group patients and was 21.0% in the NC group patients. The RFS tended to be worse in the C group than in the NC group (p=0.1756). The OS rate at five years after surgery was 7.4% in the C group and 22.8% in the NC group, which was significantly different (p=0.0189). The multivariate analysis demonstrated that postoperative complications and lymphatic invasion were significant independent risk factors for the RFS and OS. Conclusions: The development of postoperative complications was a risk factor for a decreased overall survival and for disease recurrence in patients who underwent curative surgery for pancreatic cancer. The surgical procedure, perioperative care and the surgical strategy should be carefully planned to avoid complications.

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-37538/v1 ◽

2020 ◽

Author(s):

Xiao-huan Ma ◽

Fang Yin ◽

Jie Zhang ◽

Meng-yun Peng ◽

Hong Guan ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Oxygen Therapy ◽

Laboratory Data ◽

Male Gender ◽

High Flow ◽

Binary Logistic Regression Analysis ◽

Hypoxemic Respiratory Failure ◽

Factors Associated ◽

Independent Risk Factors

Abstract Background Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula (HFNC) is currently the most common ventilation strategy for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with high-flow nasal canula (HFNC) oxygen therapy failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-41316/v1 ◽

2020 ◽

Author(s):

Xiao-huan Ma ◽

Fang Yin ◽

Jie Zhang ◽

Meng-yun Peng ◽

Hong Guan ◽

...

Keyword(s):

Risk Factors ◽

Laboratory Data ◽

Kidney Injury ◽

Myocardial Damage ◽

Binary Logistic Regression ◽

Male Gender ◽

Binary Logistic Regression Analysis ◽

Factors Associated ◽

Independent Risk Factors ◽

Fraction Of Inspired Oxygen

Abstract Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

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